Cluster headache

What is cluster headache?

Cluster headache is a fairly rare but very serious type of headache that occurs in groups, or ‘clusters’. Cluster headache is also referred to as Horton's neuralgia and is popularly known as suicide headache or suicidal headache because of the excruciating pain it causes.

Cluster headaches occur in attacks. The pain strikes quite suddenly, without any warning, and starts on one side of the head, around the temple. The pain is very intense, radiating to the eye socket, the ear and in some instances, the neck. Attacks can last between fifteen minutes and approximately three hours and can occur up to eight times a day.

Notably, cluster headache attacks often occur at almost the exact same time or times of the day. Cluster headaches are more common in men than women (the ratio is 3:1) and especially between the ages of 20-50.

Episodic and chronic cluster headaches

Cluster headache can be divided into episodic and chronic headaches. The episodic form is characterised by periods of weeks to months of attacks, alternated with pain-free periods. This pain-free period can last for years, after which the pain can strike again.

The chronic form has no pain-free periods and is therefore continuous. The episodic form can turn into the chronic form and vice versa.

Cluster headaches have a huge impact on everyday life and often result in memory problems, concentration problems and disability. People who suffer cluster headaches often have to deal with a lack of understanding on the part of their surroundings.

Cluster headaches should not be confused with migraines, another form of headache. People who suffer migraines often feel the attacks coming on, are nauseous and preferably want to lie still. Tension headaches are also a completely different disorder, with their own specific characteristics and causes.

What causes cluster headaches?

Although extensive research is conducted into cluster headaches, no clear cause has as yet been identified. The onset of this type of headache is thought to be related to an abnormality in the hypothalamus, a part of the brain. The hypothalamus is responsible for the regulation of various functions in the body. It controls the body’s blood pressure, heart rate, hormone balance and biological clock. The latter could be why the pain attacks often occur around the same times.

Several factors are thought to trigger a cluster headache attack. Possible triggers are alcohol consumption, cold temperatures, low levels of oxygen (for example at high altitudes) and certain flavour enhancers. However, it has not yet been proven that they actually do trigger an attack, and therefore the underlying mechanisms are still unknown.

Symptoms related to cluster headaches

The main symptom of cluster headaches is their sudden onset. Patients describe their attacks as excruciating, stabbing pain on one side of the head. The pain can radiate to the neck, the eye socket, the ear and the upper jaw on the same side of the head.

The intense pain is often accompanied by side effects, such as a stuffy nose, a tearing eye, a constricted pupil, and a drooping eyelid, all on the same side of the head as the pain. Unlike those who suffer migraines and prefer to lie still in a dark room, people with cluster headaches become very restless. They feel compelled to move and pace around.